Provider First Line Business Practice Location Address:
1360 W. SIXTH STREET
Provider Second Line Business Practice Location Address:
#210 NORTH BUILDING
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-548-3130
Provider Business Practice Location Address Fax Number:
310-548-0387
Provider Enumeration Date:
10/02/2006